Addressing racial discrimination and microaggressions in refugee mental health: insights for a discrimination-sensitive e-mental health app

Refugees are a marginalized population with high risk for trauma-related psychological distress, however, they face significant barriers to mental health care, calling for accessible e-mental health interventions. While a growing body of literature points to the relevance of societal stressors like discrimination impacting refugees’ everyday life and mental health, this has so far rarely been considered in interventional approaches. This mixed-method study provides quantitative data on the experience of racial discrimination and microaggressions and their relation to psychological distress among a sample of refugees in Germany. This is followed up by a qualitative assessment on their needs and expectations concerning a discrimination-sensitive e-mental health app. The sample of n = 44 refugees (mean age = 32.9 years, SD = 10.90; 74.4% Syrian) exhibited high levels of psychological distress with 45% reporting severe levels of depression and anxiety and 70% above the cut-off for PTSD symptoms. Racism was commonly experienced, with 59.1% of participants reporting everyday racial discrimination due to their race, and 50% due to their nationality/origin. Feelings of inferiority and similarity were the most prevalent forms of perceived racial microaggressions. Experiences of racism and microaggressions were significantly related to psychological distress (r = .32 – 0.53). Qualitative analysis identified key sub-themes for app development: participation, anonymity, a validating and discrimination-sensitive approach, cultural sensitivity, embracing diversity, education/awareness, and access. Subgroup analysis revealed that those more burdened by racial discrimination prioritized a discrimination-sensitive and participatory approach, while less burdened participants emphasized anonymity and educational aspects. These findings underscore the importance of incorporating a tailored and discrimination-sensitive approach in e-mental health apps to support refugees burdened by racial discrimination.